Papers by Stefano Salvatore
International Urogynecology Journal, May 4, 2007
Urethral sphincter deficiency (USD) is not standardised. Opening vesical pressure could reflect t... more Urethral sphincter deficiency (USD) is not standardised. Opening vesical pressure could reflect the pressure exerted to overcome urethral resistance during void; thus, we evaluated if it could discriminate USD. Women with urinary symptoms were prospectively assessed with a questionnaire and urodynamics and divided into three groups: urodynamic stress incontinence with USD (group 1), urodynamic stress incontinence related to urethral hypermobility without USD (group 2) and normal urodynamic (group 3). USD was defined as the concomitant presence of severe urodynamic stress incontinence, VLPP <60 cm H2O, MUCP <20 cm H2O and urethral mobility <30°. A total of 145 women were enrolled: 56 in group 1, 50 in group 2 and 39 in group 3. The three groups did not differ for demographics, obstetric and surgical history. The median values for opening vesical pressures were 17.5 (15.6-22.2 95%CI), 30 (27.0-37.3 95%CI) and 30 (30.6-44.2 95% CI) for the groups 1, 2 and 3, respectively. A p value <0.0001 was found when comparing group 1 either with group 2 or 3. Opening vesical pressure is a promising parameter to detect USD.
The Journal of Urology, Mar 1, 1998
OBJECTIVE The aims of this study were to determine the medium-term subjective outcome of treatmen... more OBJECTIVE The aims of this study were to determine the medium-term subjective outcome of treatment for women with a urodynamic diagnosis of detrusor instability and low bladder compliance. SETTING A tertiary referral urogynaecology clinic. PARTICIPANTS AND METHODS One thousand one hundred and five women referred for the investigation of their urinary symptoms were entered into a prospective, long term, quality of life study. Of these, 348 had a videourodynamic diagnosis of detrusor instability or low bladder compliance and form the basis of this paper. Women were contacted by post at least six months following their urodynamic assessment and asked to complete a questionnaire detailing their treatment, its efficacy and side effects, and any residual urinary symptoms. RESULTS Two hundred and fifty-six women (73.6%) responded to follow up; only 5.5% were cured of their urinary symptoms. The majority (90.2%) had received anticholinergic medication, although only 18.2% continued with this treatment in excess of six months. Many women had residual urinary symptoms following their investigation and treatment. CONCLUSION The medium term efficacy of the treatment of detrusor instability and low compliance is disappointing, and a large part of this failure may be attributable to poor treatment efficacy, side effects of medication, or inadequate follow up following the diagnosis and instigation of therapy.
Medicina
Background and Objectives: Stress urinary incontinence (SUI) negatively affects women’s quality o... more Background and Objectives: Stress urinary incontinence (SUI) negatively affects women’s quality of life, including sexual function. The aim of the current study was to evaluate the effect of polydimethylsiloxane (Macroplastique®) on sexual function in women of fertile age affected by SUI. Materials and Methods: Single-center prospective study. Sexually active women of fertile age with symptoms of pure SUI, which were urodynamically proven, were submitted to intraurethral Macroplastique® injection. At 6-months follow-up, their sexual function was evaluated with Female Sexual Function Index (FSFI), while the SUI cure rate was objectively assessed through a negative stress test and subjectively by a Patient Global Impression of Improvement (PGI-I) score < 3. The difference of coital incontinence prevalence was assessed between the baseline and the 6-month follow-up. Peri- and postoperative complications of Macroplastique® injection were recorded and classified according to the Clavi...
Clinical and Experimental Obstetrics & Gynecology, 2022
Background: In the context of extragenital endometriosis, the gastrointestinal, urinary tract, ab... more Background: In the context of extragenital endometriosis, the gastrointestinal, urinary tract, abdominal wall, and thorax localizations are considered relatively frequent, while the umbilical, inguinal, sciatic nerve, liver, and pancreas are instead ”rare”. Methods: Online searches were carried out in PubMed database of the last 20 years for these terms: extragenital endometriosis, umbilical endometriosis, inguinal endometriosis, sciatic nerve endometriosis, hepatic and pancreatic endometriosis. The following exclusion criteria were used: (1) Personal surgical history unspecified. (2) Nonspecific histological diagnosis for each type of endometriosis examined. (3) Inability to distinguish between the personal series of the author and the case reports described. (4) Proceedings of scientific meetings were not included. Tables that are easy to consult were compiled. Results: 810 titles were found among which 162 studies were selected for reading in full text and finally 114 papers were...
The Journal of Sexual Medicine, 2022
Background Genitourinary syndrome of menopause (GSM) is a widespread condition with a great impac... more Background Genitourinary syndrome of menopause (GSM) is a widespread condition with a great impact on quality of life and self-image. Aim We aimed to systematically review the current literature on CO2-Laser therapy efficacy for the treatment of GSM. Methods MEDLINE and Embase databases were systematically queried in December 2020 Studies included women with a diagnosis of Vulvo-Vaginal Atrophy (VVA) or GSM without an history of gynaecological and/or breast cancer, pelvic organ prolapse staged higher than 2, pelvic radiotherapy or Sjogren’s Syndrome. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021238121. Outcomes Effects of CO2-Laser therapy on GSM symptoms assessed through subjective or objective efficacy measurement methods. Results A total of 803 articles were identified. Of these, 25 studies were included in this review for a total of 1,152 patients. All studies showed a significant reduction in ...
Journal of biological regulators and homeostatic agents, 2017
Aesthetic surgery of female external genitalia has gained increasing popularity over the past dec... more Aesthetic surgery of female external genitalia has gained increasing popularity over the past decade, with reduction of the labia minora (labiaplasty) being the procedure most commonly requested and performed. Female external genitalia lose elasticity and volume with age, but few studies describe the techniques for labia majora augmentation. Currently, very few studies have investigated the effectiveness and safety of labia majora augmentation with hyaluronic acid (HA) injection. This study aims to evaluate the effectiveness and safety of labia majora augmentation with hyaluronic acid filler injection. We retrospectively analyzed 37 patients affected by hypotrophy of the labia majora, treated with HA dermal filler 28mg/ml PEG crosslinked (Neauvia® Intense Rose, Matex Lab, Switzerland) between May 2015 and July 2016. Global evaluation of the aesthetics of the intimate area and clinical data were investigated with VAS (Visual Analogic Scale) ad hoc. Adverse events and complications we...
Neurourology and Urodynamics, 2011
Hypothesis / aims of study The process of becoming older is genetically determined and environmen... more Hypothesis / aims of study The process of becoming older is genetically determined and environmentally modulated. The process of vaginal ageing itself can contribute to the loss of vaginal trophism, tone, support and function with a consequent increased risk of lower urinary tract symptoms and pelvic floor dysfunction. Connective tissues and collagen constituents and architecture play an important role in this ageing process. With age, in fact, collagen fibrils loose their reticular spatial disposition and, the Type I/III ratio is altered compared to premenopausal state. The aim of this study is to assess if CO2 laser at the level of vaginal mucosa can determine new collagen formation or modification as shown in the skin [1] .
Hypothesis / aims of study: to compare urinary, anal and sexual dysfunctions after laparoscopic (... more Hypothesis / aims of study: to compare urinary, anal and sexual dysfunctions after laparoscopic (LRH) and laparotomic (ARH) radical hysterectomy for cervical cancer. Study design, materials and methods: we considered retrospectively patients treated with LRH and ARH and pelvic lymphadenectomy since 2001, including patients submitted to adjuvant pelvic/vaginal radiotheraphy. We compared impact of LRH and ARH on postoperative urogynecological symptoms with ICS-standardized questionnaire; on anal symptoms with Wexner-scale; on sexual symptoms with FSFI; on QoL with VAS/Likert-scales. All questions referred to preoperatively condition and 6 months postoperatively. Results: fifty-four women were included, 27 LRH and 27 ARH. Patient’s characteristics were comparable between two groups. In both groups 13 patients had radiotheraphy. No conversion from laparoscopy to laparotomy. One bladder and 1 ureteral injuries (7.4%) during LRH and 1 (3.7%) ureteral injury during ARH occurred (p=1.0). Pr...
Neurourology and Urodynamics, 2020
European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 2019
To evaluate the safety, feasibility and efficacy of trans-vaginal fractional micro-ablative CO 2 ... more To evaluate the safety, feasibility and efficacy of trans-vaginal fractional micro-ablative CO 2 laser therapy in combination with platelet rich plasma (PRP) for the treatment of stress urinary incontinence (SUI) in women. Study design: Participants with SUI underwent three sessions of transvaginal CO 2 laser and PRP treatment, administered at 4-6-week intervals. Outcomes were assessed using the bladder function section of the Australian Pelvic Floor Questionnaire (APFQ). The primary outcome was changes in the participants' symptoms of SUI. Secondary outcomes were related to general bladder function. Outcome differences from baseline (T1) to 3 months (T2) and 12 months (T3) were analysed using Wilcoxon signed-rank tests. Subjective verbal scales were used to assess the degree of pain associated with PRP injections and laser treatment. Results: Sixty-two women with SUI were enrolled into this study. There were 66% (41/62) of participants who reported improved SUI symptoms from T1 to T2 (p < 0.001) and at T3, 62% (23/37) of patients reported improved SUI symptoms (p < 0.001). From T1 to T2, all bladder function variables were improved significantly (p < 0.002). At T3, significant improvements (p < 0.03) were maintained for all bladder function variables, except pad usage (p = 0.073). Conclusions: Combining transvaginal fractional CO 2 laser with PRP might be a beneficial treatment for SUI. It may have the potential to be a minimally-invasive and low-risk alternative to surgery, with reduced recovery time.
Neurourology and Urodynamics, 2019
Lasers in Medical Science, 2019
To alert patients and health care providers about the use of energy-based devices to perform a va... more To alert patients and health care providers about the use of energy-based devices to perform a vaginal Brejuvenation,^cosmetic vaginal procedures, or nonsurgical vaginal procedures to treat symptoms related to menopause, urinary incontinence, or sexual function, the US Food and Drug Administration (FDA) has issued a warning about the effectiveness and safety of such devices. We agree with the FDA that certain devices (laser, radiofrequency, etc.) have been marketed inappropriately for uses that are outside of their cleared or approved intended uses. We want to position ourselves in the strict training of professionals so that the indications and techniques are used in the best possible way, knowing that, similar to any medical or surgical technique, the side effects can appear in the short and long term, and should be recognized and remedied.
Ultraschall in der Medizin - European Journal of Ultrasound, 2010
Climacteric, 2014
Objective This pilot study aimed to assess the effi cacy and feasibility of fractional CO 2 laser... more Objective This pilot study aimed to assess the effi cacy and feasibility of fractional CO 2 laser in the treatment of vulvovaginal atrophy (VVA) in postmenopausal women. Methods VVA symptoms were assessed before and after three applications of laser over 12 weeks in 50 women (age 59.6 ϩ Ϫ 5.8 years) dissatisfi ed with previous local estrogen therapies. Subjective (visual analog scale) and objective (Vaginal Health Index Score, VHIS) measures were used during the study period to assess VVA. Quality of life was measured by using the SF-12. A subjective scale to evaluate the degree of pain related to the laser application and the degree of diffi culty to perform the laser procedure was used. Results Fractional CO 2 laser treatment was effective to improve VVA symptoms (vaginal dryness, vaginal burning, vaginal itching, dyspareunia, dysuria; p Ͻ 0.001) at 12-week follow-up, as well as the VHIS (13.1 ϩ Ϫ 2.5 at baseline vs. 23.1 ϩ Ϫ 1.9; p Ͻ 0.001). Both physical and mental scores of quality of life were signifi cantly improved in comparison with baseline (p Ͻ 0.001). Satisfaction with the laser procedure was reported by 42 women (84%) and a minimal discomfort was experienced at the fi rst laser application, mainly because of the insertion and the movements of the probe. Finally, the technique was very easy to perform in all women starting from the second application at week 4 and no adverse events were recorded during the study period. Conclusions A 12-week treatment with the fractional CO 2 laser was feasible and induced a signifi cant improvement of VVA symptoms by ameliorating vaginal health in postmenopausal women. Further controlled studies should be performed to confi rm the present data and to assess the long-term effects of the laser procedure on vaginal tissues.
Neurourology and Urodynamics, 2002
European Journal of Obstetrics & Gynecology and Reproductive Biology, Apr 1, 2005
Prospective randomized trial to compare two low starting doses of oxybutynin, using an incrementa... more Prospective randomized trial to compare two low starting doses of oxybutynin, using an incremental regimen to assess patient compliance and treatment efficacy in the long-term. Women with detrusor overactivity were included. Oxybutynin was randomly prescribed with a starting dose of either 2.5 mg bd or 5 mg nocte. Instructions were given to increase oxybutynin up to 5 mg tds over a period of 6 weeks fortnightly. After two years we re-contacted all the women, using a specific questionnaire to assess the efficacy, acceptability and compliance with these two different regimens. Twenty-two women in each group were calculated to show a 5% difference with a significance of 0.05 and a power of 0.9. The chi2-test was used to compare the two groups and a P-value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 was considered significant. Ninety-six women were included; 66 (68.75%) (mean age 57.5 years) responded to our questionnaire. Twenty-seven had a starting dose of 2.5 mg oxybutynin twice a day and 39 of 5 mg nocte. 34.8% complained of side effects. Only 19 (43.2%) out of the 44, not on medication anymore abandoned oxybutynin for adverse reactions. Most of the patients stopped oxybutynin within 4 months. 53.0% reported improvement or cure. 39.4% denied any benefit and 7.6% (none still on oxybutynin) did not answer. The two groups did not differ for duration of treatment, improvement with oxybutynin, maximum dose they reached, the present dose, and the present urinary symptoms. This study did not show any advantage in efficacy or compliance with oxybutynin when two different regimens of low starting were used. Two-thirds of patients discontinued the therapy within 4-6 months. Therefore, patients on anticholinergics should be reassessed after 6 months in clinical practice.
Uploads
Papers by Stefano Salvatore